[ photo by Nasik Lababan]

Types of stroke.

You received a call from the hospital that your Mom has had a stroke. That is a scary call to receive. There are so many questions that immediately begin to run through your mind. A stroke is a very serious medical diagnosis that has a very broad range of symptoms and a highly variable prognosis/recovery.

There are two main types of stroke, ischemic and hemorrhagic. The ischemic stroke occurs when there is some sort of blockage to an artery of the brain causing a loss of blood flow to a particular area of the brain. A hemorrhagic stroke occurs when there is a rupture of a vessel in the brain, causing bleeding in the brain.

Both can have varying  consequences, so it is important to first determine what type of stroke Mom had. First, Mom will have a CT scan (aka CAT scan) to determine the type of stroke, which helps to guide the initial treatment. Once this is identified, the treating team (neurologist, internal medicine and, sometimes, neurosurgeon) decide on the next steps of treatment.

Next type of stroke imaging.

In this example Mom had an ischemic stroke (blood vessel blockage) and she did not fall within the parameters that are required to receive tPA, which is a medication given intravenously to break up the blood clot. The next step is to assess the area of stroke, usually done via MRI. This tells the neurologist exactly what artery of the brain was blocked.

During this process, it is essential to get Mom’s blood pressure down, as elevated blood pressure is usually seen during and immediately after a stroke. In the first days of her stroke, it’s a dance. Mom’s blood pressure needs to be a little high in order to make sure blood is getting to the area of the brain that experienced the stroke, but the blood pressure shouldn’t be so high so as to potentially lead to bleeding in that area of the brain where the stroke occurred.

Because of the need for close monitoring of these vital signs, she will likely go to the ICU initially. Once she is stabilized, she will continue with the stroke work-up to see what might have led to this.

Testing after brain imaging.

 If she hasn’t already, she will receive an ECG (aka EKG) to assess if her heart is in an abnormal rhythm that might have caused a formation of a clot that traveled to the brain. Next, an echocardiogram might be performed. This is an ultrasound of the heart to look at how well the heart is functioning and to see if there are any abnormalities of the heart that might have led to the stroke.

Good news, her heart is in normal rhythm and the heart function is near normal for Mom’s age. Now it’s time to look at the carotid arteries, which are the blood vessels that travel up both sides of the neck to supply blood to the brain. Over time, blockages can develop on one or both sides, which can lead to a stroke.

The percentage of blockage on each side determines if she will need further treatment of these blockages down the road. Smaller blockages can be managed with lifestyle changes and medications, but larger blockages usually require additional surgical intervention. Throughout all of these tests she is undergoing, blood work is also being done. One big thing being checked is her cholesterol panel. Elevated cholesterol is a risk factor for stroke, so this is important to know. 

Ischemic stroke next steps.

So Mom’s results are all back, and there is not anything that stands out too much, other than the definitive findings of the stroke on the scans. Her cardiac (heart) workup looks okay, and the ultrasound of her carotid arteries show some small blockages on both sides, but the neurologist tells the family neither blockage is large enough to require any further intervention.

The next steps are to make sure she is on the right medications in order to,  hopefully, prevent another stroke. These medications usually include some sort of blood thinner (based on what Mom was taking before), cholesterol lowering medications (“statin”) and, if necessary, a blood pressure medication to keep her blood pressure within the desired range. This whole process usually takes a few days.

During these past few days, Mom should have been evaluated by physical therapy, occuaptional therapy, and speech therapy so that as soon as the neurologist and any other treating doctors say she is medically stable, she will be able to move on to the next stage...rehab!

Hopefully, you now know what types of stroke testing to expect after a stroke occurs. While this case was relatively straightforward, each individual situation will be quite variable. If your situation is complex and you are searching for answers please reach out to me for guidance regarding your unique situation.

Please leave a comment if you have a question or experience to share about the impact of a stroke on you or your loved one’s life.

© 2020 Jessica Kluetz, DO